Subjects who are categorical Internal Medicine residents at Penn State Hershey Medical Center (PGY1-PGY3), and meet inclusion/exclusion criteria, will be enrolled in this study and wear the WHOOP strap 3.0 for real-time measurement of physiologic metrics.

Resident Wellness

Resident Burnout

Sleep

Stress

Anxiety

Depression

WHOOP strap 3.0, a photodiode-based device that tracks sleep, resting heart rate, and heart rate variability.

WHOOP strap 3.0

WHOOP measures 3 physiological markers: Heart Rate Variability (HRV), Resting Heart Rate (RHR), and sleep. HRV measures the variation in time between each heart beat. RHR is measured during sleep each night for consistent, controlled readings.

Penn State Hershey Medical Center

Remote Physiologic Monitoring of Resident Wellness and Burnout

Heart Rate Variability will be objectively measured nightly. Average HRV (over two weeks) will be assessed for change every two weeks over the duration of the study.

Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)). The MBI-HSS (MP) is a variation of the MBI-HSS adapted for medical personnel. The most notable alteration is this form refers to "patients" instead of "recipients". The MBI-HSS (MP) scales are Emotional Exhaustion (9 questions), Depersonalization (5 questions), and Personal Accomplishment (8 questions).
Maslach Burnout Inventory score will be assessed every two weeks in survey format. Each question is scored 0-6, thus the subscale ranges are 0-54, 0-30, 0-48, respectively, with higher scores signifying higher levels of burnout for the emotional exhaustion and depersonalization subscales and lower scores signifying higher levels of burnout for the personal accomplishment subscale.

Sleep will be objectively measured nightly. Sleep (hours per night) will be assessed for change every two weeks over the duration of the study (average sleep per night over two weeks). Subscales for sleep will include duration of rapid eye movement (REM), slow wave sleep (SWS), and light sleep. Time in bed and naps will also be recorded.

Resting Heart Rate will be objectively measured nightly. Average RHR (over two weeks) will be assessed for change every two weeks over the duration of the study.

Weekly duty hours will be self-reported every two weeks, individually as week 1 hours and week 2 hours. Week 1 and week 2 hours will be averaged for each two-week block.

The Mini-Z comprises 15 items which assess satisfaction, stress, burnout, work control, chaos, values alignment, teamwork, documentation, time pressure, excess electronic medical record (EMR) use at home, and EMR proficiency. It is scored on a scale of 15-76. A total score greater 60 represents a positive learning environment. Subscale 1 - Supportive Work Environment (questions 1-5): range 6-26 (greater than 20 is a highly supportive work environment). Subscale 2 - Work pace and EMR Stress (questions 6-10: range 5-25 (greater than 20 is an environment with good pace and manageable EMR stress). Subscale 3 - Resident Experience (questions 11-15): range 5-25 (greater than 20 is a positive and healthy resident experience).
Mini-ReZ will be assessed every two weeks in survey format.

The Physician Well Being Index is a 7 question survey, scored 0-7, with lower scores indicative of better physician well being.

The PHQ-9 is a 9-question instrument given to subjects in a primary care setting to screen for the presence and severity of depression. PHQ-9 score will be assessed every two weeks in survey format. It is scored on a 0-27 scale, with higher scores signifying higher levels of depression. The PHQ-9 scores indicate mild (<4) to severe (20+) severe PD. The PHQ-9 also has a self-report item for suicidal ideation (SI).

The HADS consists of two scales; A (anxiety) - with 7 items [Cronbach's alpha = 0.78] and D (depression) - with 7 items [Cronbach's alpha = 0.71], each with scores ranging from 0-21; total scale scores range from 0-42, with higher scores indicating more distressing symptoms. The HADS has been validated with primary care patients.

The PSS-4 consists of 4 items that assess perceived stress. The items are scored on a 4-point scale (Score range: 0-16; higher scores reflect greater perceived stress. The measure demonstrates strong internal consistency with a Cronbach's alpha of .88.

Saliva samples will be collected during baseline assessment (2 consecutive days) and during outpatient clinic/inpatient consult services (low stress) and ICU (high stress) rotations (weekly for 4 weeks, every Friday). Each collection day will have 3 collection times: wake-up (t=0), wake-up time + 30 min (t=30), night time (just prior to sleep) (NT).

Andrew Tinsley

Associate Professor, Gastroenterology

Milton S. Hershey Medical Center

No raga. Just collection of electrophysiological parameters will be done.

Hypertension

A raga will be played for 10 minutes & data collected.

Music Intervention

M S Ramaiah Medical college and hospitals

Indian Ragas on Health - a Electrophysiological Study (RAGA-1)

Assessment of the Effect of Various Ragas of Indian Music on Electrophysiological Parameters and Salivary Stress Markers - a Randomized Control Trial

Described in methodology - before & after music intervention measurements will be done. (in microunits/cu.mm of saliva)

alpha amylase/infarction

Remote Physiologic Monitoring of Resident Wellness and Burnout

Indian Ragas on Health - a Electrophysiological Study (RAGA-1)

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